Skip to main content

Advertisement

SpringerLink
Log in

Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Early integration of palliative care into cancer disease management is beneficial for patients with advanced tumors. However, little is known about the association of palliative care interventions with symptom burden and treatment aggressiveness at the end of life (EoL).

Methods

To assess determinants of symptom burden and treatment intensity at the EoL, a retrospective chart review was conducted in university cancer clinic outpatients who died between July 2009 and June 2011. The objective was the correlation of place of death, palliative care utilization, prior EoL discussion, and social background (determinant variables) with symptom burden and treatment intensity (outcome variables).

Results

Ninety-six patients (61 men and 35 women) died; the mean age at death was 62.4 years (range 24–83). Mean duration of treatment was 17.9 months (range 1–129). Data on the last 14 days (3) of life were available for 62 (44) patients. Forty-seven patients received aggressive EoL care which was strongly associated with hospital death (p = 0.000, χ 2 test). The 15 patients having used palliative care services or dying in a palliative care unit (PCU) had fewer symptoms (p = 0.006, t test) and interventions (p = 0.000, t test) at the EoL. Having addressed EoL issues was correlated with fewer procedures during the last 3 days (p = 0.035, t test).

Conclusions

Most cancer patients receive aggressive EoL care interfering with quality of life. Despite limitations by small sample size and missing data, the results suggest that palliative care utilization is associated with reduced symptom burden and intensity of treatment at the EoL. Timely discussion of EoL issues may reduce the number of unnecessary interventions and facilitate referral to the PCU.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC et al (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26:3860–3866

    Article  PubMed  Google Scholar 

  2. Bendaly EA, Groves J, Juliar B, Gramelspacher GP (2008) Financial impact of palliative care consultation in a public hospital. J Palliat Med 11:1304–1308

    Article  PubMed  Google Scholar 

  3. Casarett D, Pickard A, Bailey FA, Ritchie C, Furman C et al (2008) Do palliative consultations improve patient outcomes? J Am Geriatr Soc 56:593–599

    Article  PubMed  Google Scholar 

  4. Hanson LC, Usher B, Spragens L, Bernard S (2008) Clinical and economic impact of palliative care consultation. J Pain Symptom Manag 35:340–346

    Article  Google Scholar 

  5. Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A et al (2008) Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 168:1783–1790

    Article  PubMed  Google Scholar 

  6. Zimmermann C, Riechelmann R, Krzyzanowska M, Rodin G, Tannock I (2008) Effectiveness of specialized palliative care: a systematic review. JAMA 299:1698–1709

    Article  PubMed  CAS  Google Scholar 

  7. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC et al (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302:741–749

    Article  PubMed  CAS  Google Scholar 

  8. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    Article  PubMed  CAS  Google Scholar 

  9. Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD et al (2010) Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol 28:4457–4464

    Article  PubMed  Google Scholar 

  10. Ho TH, Barbera L, Saskin R, Lu H, Neville BA et al (2011) Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol 29:1587–1591

    Article  PubMed  Google Scholar 

  11. Gonsalves WI, Tashi T, Krishnamurthy J, Davies T, Ortman S et al (2011) Effect of palliative care services on the aggressiveness of end-of-life care in the Veteran’s Affairs cancer population. J Palliat Med 14:1231–1235

    Article  PubMed  Google Scholar 

  12. Stiel S, Pollok A, Elsner F, Lindena G, Ostgathe C et al (2012) Validation of the symptom and problem checklist of the German Hospice and Palliative Care Evaluation (HOPE). J Pain Symptom Manag 43:593–605

    Article  Google Scholar 

  13. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655

    Article  PubMed  CAS  Google Scholar 

  14. Hearn J, Higginson IJ (1999) Development and validation of a core outcome measure for palliative care: the palliative care outcome scale. Palliative Care Core Audit Project Advisory Group. Qual Health Care 8:219–227

    Article  PubMed  CAS  Google Scholar 

  15. Mack JW, Cronin A, Keating NL, Taback N, Huskamp HA et al (2012) Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study. J Clin Oncol 30:4387–4395

    Article  PubMed  Google Scholar 

  16. Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138

    Article  PubMed  Google Scholar 

  17. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD et al (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315–321

    Article  PubMed  Google Scholar 

  18. Tang ST, Wu SC, Hung YN, Chen JS, Huang EW et al (2009) Determinants of aggressive end-of-life care for Taiwanese cancer decedents, 2001 to 2006. J Clin Oncol 27:4613–4618

    Article  PubMed  Google Scholar 

  19. Gaertner J, Wolf J, Hallek M, Glossmann JP, Voltz R (2011) Standardizing integration of palliative care into comprehensive cancer therapy—a disease specific approach. Support Care Cancer 19(7):1037–1043

    Article  PubMed  Google Scholar 

  20. Gaertner J, Wolf J, Frechen S, Klein U, Scheicht D et al (2011) Recommending early integration of palliative care—does it work? Support Care Cancer 20(3):507–513

    Article  PubMed  Google Scholar 

  21. Kelley AS, Morrison RS, Wenger NS, Ettner SL, Sarkisian CA (2010) Determinants of treatment intensity for patients with serious illness: a new conceptual framework. J Palliat Med 13:807–813

    Article  PubMed  Google Scholar 

  22. Nappa U, Lindqvist O, Rasmussen BH, Axelsson B (2011) Palliative chemotherapy during the last month of life. Ann Oncol 22:2375–2380

    Article  PubMed  CAS  Google Scholar 

  23. Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC (2011) The effect on survival of continuing chemotherapy to near death. BMC Palliat Care 10:14

    Article  PubMed  Google Scholar 

  24. Fukui S, Fujita J, Tsujimura M, Sumikawa Y, Hayashi Y et al (2011) Late referrals to home palliative care service affecting death at home in advanced cancer patients in Japan: a nationwide survey. Ann Oncol 22:2113–2120

    Article  PubMed  CAS  Google Scholar 

  25. Smith CB, Nelson JE, Berman AR, Powell CA, Fleischman J et al (2012) Lung cancer physicians’ referral practices for palliative care consultation. Ann Oncol 23:382–387

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The work was funded by an unrestricted grant by the local support group, “association for support of the tumor center of the Erlangen-Nürnberg University.”

Conflict of interest

The authors declare that they have no conflicts of interest. They have full control of and access to the primary data and allow the journal to review the data at request.

Author information

Authors and Affiliations

  1. Departement of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Johannes Bükki, Julia Scherbel, Stephanie Stiel, Carsten Klein & Christoph Ostgathe

  2. Interdisciplinary Center for Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-Universität, Marchioninistr.15, 81377, Munich, Germany

    Johannes Bükki

  3. Department of Internal Medicine, Hematology, and Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Norbert Meidenbauer

Authors
  1. Johannes Bükki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Scherbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Stiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carsten Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norbert Meidenbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Ostgathe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes Bükki.

Additional information

Johannes Bükki and Julia Scherbel contributed equally to this manuscript.

Appendix

Appendix

Patient self-report questionnaire

figure a

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bükki, J., Scherbel, J., Stiel, S. et al. Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review. Support Care Cancer 21, 1743–1750 (2013). https://doi.org/10.1007/s00520-013-1721-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1721-y

Keywords

Search

Navigation